<html>
  <head>
<title>Register</title>
<meta charset="utf-8">
</head>
<body>
<h1>Register</h1>
<form name="register_form" method="POST" action="reg_new_user.php">
  <table>
    <tr><td>Gender</td>
      <td>
	<input type="radio" name="gender_type" value="male"><label for="Male">Male</label>
	<input type="radio" name="gender_type" value="female"><label for="Female">Female</label>
      </td>
    </tr>
    <tr>
      <td>First Name:</td>
      <td><input type="text" name="first_name"></td>
    </tr>
    <tr>
      <td>Last Name:</td>
      <td><input type="text" name="last_name"></td>
    </tr>
    <tr>
      <td>Date of Birth:</td>
      <td><input type="text" name="date_of_birth"></td>
    </tr>
    <tr>
      <td>E-Mail Address:</td>
      <td><input type="text" name="e_mail"></td>
    </tr>
    <tr>
      <td>Street Address:</td>
      <td><input type="text" name="street_address"></td>
    </tr>
    <tr>
      <td>State/Province:</td>
      <td><input type="text" name="state_province"></td>
    </tr>
    <tr>
      <td>Telephone Number:</td>
      <td><input type="text" name="tel_number"></td>
    </tr>
      <tr>
      <td>Identity:</td>
      <td><input type="text" name="identity_card"></td>
    </tr>
    <tr>
      <td>Username:</td>
      <td><input type="text" name="username"></td>
    </tr>
    <tr>
      <td>Password:</td>
      <td><input type="password" name="password"></td>
    </tr>
    <tr>
      <td>Password(2):</td>
      <td><input type="password" name="password_conf"></td>
    </tr>
    
	</table>
  <input type="submit" value="Continue">
  </form>
<address>
<a href="mailto:thien@thien-PC">U-thien-PC\thien</a>
</address>
</body>
</html>
